BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  SB 1045
                                                                  Page  1


          SENATE THIRD READING
          SB 1045 (Beall)
          As Amended June 15, 2014
          Majority vote

           SENATE VOTE  :35-0  
           
           HEALTH              17-0                                        
           
           ----------------------------------------------------------------- 
          |Ayes:|Pan, Maienschein,         |     |                          |
          |     |Ammiano, Bonilla, Bonta,  |     |                          |
          |     |Chesbro, Gomez, Roger     |     |                          |
          |     |Hernández, Lowenthal,     |     |                          |
          |     |Mansoor, Nazarian,        |     |                          |
          |     |Nestande, Patterson,      |     |                          |
          |     |Ridley-Thomas, Rodriguez, |     |                          |
          |     |Wagner, Wieckowski        |     |                          |
          |     |                          |     |                          |
           ----------------------------------------------------------------- 
           SUMMARY :  Changes the number of individuals allowed in a group  
          to a minimum of two and a maximum of 14 for outpatient drug free  
          services for the purposes of Drug Medi-Cal (DMC) reimbursement  
          and requires at least one individual in the group to be a  
          Medi-Cal eligible beneficiary; for groups consisting of two  
          individuals, the individual that is not a Medi-Cal eligible  
          beneficiary must be receiving outpatient drug free services for  
          a diagnosed substance abuse disorder.

           EXISTING LAW  :

          1)Establishes the Medi-Cal program, administered by the  
            Department of Health Care Services (DHCS), under which  
            qualified low-income individuals receive health care services.

          2)Establishes the DMC program, which provides substance use  
            disorder services to Medi-Cal recipients.

          3)Allows DHCS to enter into contracts with counties for the  
            provision of DMC services.  If a county declines to contract  
            with DHCS, existing law requires DHCS to contract for services  
            in the county to ensure beneficiary access.

          4)Requires each county to fund the nonfederal share for DMC  








                                                                  SB 1045
                                                                  Page  2


            services through realignment funds, as specified.

          5)Requires providers of DMC services to obtain certification  
            from DHCS to provide those services.

          6)Requires a group for outpatient drug free services and  
            narcotic treatment programs to consist of a minimum of four  
            and a maximum of 10 individuals, of which at least one must be  
            a Medi-Cal-eligible beneficiary.

           FISCAL EFFECT  :  None

           COMMENTS  :  According to the author, even though DMC treatment  
          services have been expanded, many counties find it difficult to  
          offer these benefits due to state restrictions, such as the  
          limitation on group size for outpatient treatment (counseling  
          services).  Current state law specifies that outpatient  
          counseling groups must have between four and 10 participants in  
          order for the program to bill for and receive Medi-Cal  
          reimbursement.

          The author further states that this restriction poses a problem  
          for both small and large population counties.  Small population  
          rural counties, in which program participants may have to travel  
          long distances to attend group counseling sessions, often have  
          trouble getting four or more people together for a group, but if  
          they have less than four participants, they cannot receive  
          Medi-Cal reimbursement for that counseling session.  Large  
          population counties have the opposite problem.  According to the  
          author, when more than 10 people show up for a group session, a  
          common occurrence, some participants may have to be excluded,  
          otherwise the county cannot bill Medi-Cal for any of the  
          services provided to the Medi-Cal-eligible participants.  Thus,  
          the group size restriction presents a significant barrier to  
          effective treatment.

          Alcohol and other drug use disorders are substantial public  
          health problems, affecting approximately 10% of the population  
          and resulting in economic costs to the nation of around $360  
          billion annually, with roughly half of this amount attributable  
          to alcohol use disorders (Office of National Drug Control Policy  
          2004).  According to the National Institute on Drug Abuse, in  
          2011, 21.6 million people aged 12 years or older needed  
          treatment for an illicit drug or alcohol use problem, but only  








                                                                  SB 1045
                                                                  Page  3


          2.3 million received treatment at a specialty substance abuse  
          facility.

          Mental Health America of California and the California Council  
          of Community Mental Health Agencies, write that this bill  
          creates more flexibility in group outpatient drug free services  
          under the DMC program by decreasing the minimum size from four  
          to two and increasing the maximum size from 10 to 14.  They  
          argue that given the shortage of facilities and low  
          reimbursement rates that create a significant access problem,  
          this bill helps address that problem. 

          This bill has no opposition.


           Analysis Prepared by  :    Paula Villescaz / HEALTH / (916)  
          319-2097 


                                                                FN: 0003943